| Surgical prophylaxis in women at increased genetic risk for both ovarian and breast cancer
Women
who have a strong family history of breast cancer and/or carry a mutation
in a breast and ovarian cancer predisposition gene (BRCA1 or BRCA2)
have much higher risks for one or both cancers. In such women, bilateral
risk-reducing mastectomy (BRRM) and bilateral risk-reducing
salpingo-oophorectomy (BRRO) significantly reduces the risk of breast and
BRCA-associated gynaecological cancers (ovarian, fallopian tube and
primary peritoneal) respectively. To date, the reported uptake of risk
reducing surgery as a risk management strategy is extremely varied. We
undertook a study of Australian women 3 years after they had attended a
Family Cancer Centre. When compared to uptake of BRRM,
a greater number of women elect to undergo BRRO, indicating that
oophorectomy may be a more acceptable risk management strategy. We found
that 4.4% women had elected to undergo BRRM; with no difference found
between moderate and high risk groups. BRRO was undertaken by 17.3%, more
commonly in women older than 40 (P=0.023) and with a BRCA1/2
mutation (P=0.017).The experience of seeing other family members affected
by cancer is likely to contribute to an individual’s perceptions of risk
and cancer specific anxiety and we found that BRRM was associated with
increasing numbers of affected relatives (P=0.025). We also found that
those women with greater levels of cancer specific anxiety were more
likely to indicate that BRRM would be something they would consider in the
future (P<0.001). Similarly
women with a low perception of their breast cancer risk were more likely
indicate that they would not consider mastectomy as a risk management
strategy (P=0.035). In contrast, we did not find that BRRM was associated with
objective breast cancer risk; with moderate risk women just as likely to
undergo the procedure as high risk women. Currently, surgical prophylaxis is the major method of risk reduction for women at increased genetic risk for both ovarian and breast cancer and yet it would appear from the results of this and other studies that both BRRO and BRRM are acceptable as a means of risk reduction to only a small percentage of women. The way in which women are counselled about risk reducing surgery together with clinician driven preferences are likely to weight pressure in decision-making; however this is almost certainly combined with individual influences such as previous cancer experiences.
Bibliographical reference:
Yoland Antill Department of Haematology and Medical Oncology, Peter MacCallum Cancer Centre, Locked Bag 1, A'Beckett Street, Melbourne 8006, Vic., Australia
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